Provider Demographics
NPI:1962688895
Name:COOK, BRIAN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2920 MCINTIRE DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403
Mailing Address - Country:US
Mailing Address - Phone:812-332-9217
Mailing Address - Fax:812-330-4474
Practice Address - Street 1:2920 MCINTIRE DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-332-9217
Practice Address - Fax:812-330-4474
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01064947A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200897380Medicaid
IN548980RMedicare PIN